How to Improve Quality of Life, Near DeathPosted on March 19, 2014 by ElderCare Resources in Blog, Caregiver Education, Education, Geriatric Care Management, Home Health Care Medical, Hospice & Palliative Care, Long Term Care Information
How can we reduce end-of-life health care costs?
PETER PRONOVOST: End-of-life care is a difficult but important topic of conversation for patients, their loved ones and members of the health care team.
One treatment that may reduce end-of-life health costs—but most importantly, improve quality of life for people living with advanced diseases—is to encourage these individuals to consider whether palliative care and hospice are appropriate.
The goal of palliative care is to help patients living with an advanced disease like cancer or a chronic disease like heart failure to live more comfortably. While hospice care seeks to alleviate pain and suffering during the final days and hours of life, palliative care is delivered alongside traditional therapies focused on eliminating disease and improving health. The combination of palliative care with typical care improves symptoms, lessens depression and anxiety, improves people’s knowledge of their prognosis, helps them set appropriate goals for care, and leads to more and earlier use of hospice.
Although most patients want to live as long and as well as they can and then die at home quietly among their loved ones, that often doesn’t happen. In a study of end-of-life care for Medicare beneficiaries with cancer, 60% of Medicare patients with poor prognosis cancer were hospitalized during their last month of life. Of those, half will die in the hospital. All of that care adds up. The amount that Medicare spends in the last month of life has remained at 25% of the total Medicare budget from 1978 to 2006.
The remedy for this is to open up a dialogue between patients and their loved ones, and then with their medical team. Everyone should get an advance directive and appoint a durable power of attorney. These documents allow you to spell out exactly what you want and who can make medical decisions for you if you are unable to make your own. If you are seriously ill, ask your doctors about your prognosis, what life will be like in the future and how you can plan. There is no denying it—these are hard conversations for patients and doctors. Doctors don’t like to give estimates, the science is inexact and we often use ambiguous language such as the prognosis is poor. Yet most advanced diseases are predictable when the prognosis is six months or less.
I asked Dr. Tom Smith, director of the palliative care program at The Johns Hopkins Hospital, how to remedy this. He said, “If you have a serious illness, do these things now while you have the energy. In our experience, people put these important issues off, and all of the sudden it’s too late and they don’t have the time or energy to make them happen.”
Dr. Peter Pronovost is a practicing anesthesiologist, critical-care physician, professor, Johns Hopkins Medicine senior vice president and director of the Armstrong Institute for Patient Safety and Quality.
Published: The Wall Street Journal